test page - Chemwatch

There are two options for course payment

Credit card or Paypal: For these methods, continue filling out this form.

Invoicing Chemwatch for payment: If you choose this option, please email learning@chemwatch.net, with information detailing the number of enrolments you would like to purchase. DO NOT FILL OUT THE FORM YET. Once the payment has gone through, you can fill out this form, using the license code we send through.

Please complete all questions below.

Personal details

1. Enter your full name

Family name (surname): *

First given name: *

Second given name (middle):

2. Enter your birth date *

3. Gender (Tick ONE box only) *

Male
Female
Other

4. Enter your contact details

Email address *

Confirm Email

Home phone

Work phone

Mobile *

5. Residential Address

Building/property name

Flat/unit details

Street or lot number (e.g. 205 or Lot 118) *

Street name *

Suburb, locality or town *

State/territory *

Postcode *

Country

6. What is your postal address (if different from above)?

Postal Address

Same as residential address

Building/property name

Flat/unit details

Street or lot number (e.g. 205 or Lot 118)

Street name

Postal delivery information (e.g. PO Box 254)

Suburb, locality or town

State/territory

Postcode

Country

Language and cultural diversity

7. In which country were you born? *

Australia
Other

8. Do you speak a language other than English at home? (If more than one language, indicate the one that is spoken most often) *

No, English only
Yes, please specify

9. Are you of Aboriginal or Torres Strait Islander origin? (For persons of both Aboriginal and Torres Strait Islander origin, mark both ‘Yes’ boxes) *

No
Yes, Aboriginal
Yes, Torres Strait Islander
Yes, Aboriginal and Torres Strait Islander

Disability

10. Do you consider yourself to have a disability, impairment or long-term condition? *

Yes
No – Go to question 12

11. If you indicated the presence of a disability, impairment or long-term condition, please select the area(s) in the following list: (You may indicate more than one area) Please refer to the Disability supplement for an explanation of the following disabilities.

Hearing/deaf
Physical
Intellectual
Learning
Mental illness
Acquired brain impairment
Vision
Medical condition
Other

Schooling

12. What is your highest COMPLETED school level? (Tick ONE box only). If you are currently enrolled in secondary education, the Highest school level completed refers to the highest school level you have actually completed and not the level you are currently undertaking. For example, if you are currently in Year 10 the Highest school level completed is Year 9. *

Year 12 or equivalent
Year 11 or equivalent
Year 10 or equivalent
Year 9 or equivalent
Year 8 or below
Never attended school

13. Are you still enrolled in secondary or senior secondary education? *

Previous qualifications achieved

14. Have you SUCCESSFULLY completed any of the qualifications listed in question 15? *

No – go to question 16

15. If YES, tick ANY applicable boxes.

Bachelor degree or higher degree
Advanced diploma or associate degree
Diploma (or associate diploma)
Certificate IV (or advanced certificate/technician)
Certificate III (or trade certificate)
Certificate II
Certificate I
Other education (including certificates or overseas qualifications not listed above)

Employment

16. Of the following categories, which BEST describes your current employment status? (Tick ONE box only) For casual, seasonal, contract and shift work, use the current number of hours worked per week to determine whether full time (35 hours or more per week) or part-time employed (less than 35 hours per week). *

Full-time employee
Part-time employe
Self employed – not employing others
Self employed – employing others
Employed – unpaid worker in a family business
Unemployed – seeking full-time work
Unemployed – seeking part-time work
Not employed – not seeking employment

Study reason

17. Of the following categories, select the one which BEST describes the main reason you are undertaking this course/traineeship/apprenticeship (Tick ONE box only) *

To get a job
To develop my existing business
To start my own business
To try for a different career
To get a better job or promotion
It was a requirement of my job
I wanted extra skills for my job
To get into another course of study
For personal interest or self-development
To get skills for community/voluntary work
Other reasons

Unique Student Identifier (USI)

From 1 January 2015, Chemwatch can be prevented from issuing you with a nationally recognised VET qualification or statement of attainment when you complete your course if you do not have a Unique Student Identifier (USI). In addition, we are required to include your USI in the data we submit to NCVER. If you have not yet obtained a USI you can apply for it directly at https://www.usi.gov.au/students/create-your-usi/ on computer or mobile device.

Enter your Unique Student Identifier (USI) (if you already have one). You may already have a USI if you have done any nationally recognised training, which could include training at work, completing a first aid course or RSA (Responsible Service of Alcohol) course, getting a white card, or studying at a TAFE or training organisation. It is important that you try to find out whether you already have a USI before attempting to create a new one. You should not have more than one USI. To check if you already have a USI, use the ‘Forgotten USI’ link on the USI website at https://www.usi.gov.au/faqs/i-have-forgotten-my-usi/. *

Unique Student Identifier (USI)

Do you have access to a computer with internet? *

I understand that this is an online course and that I will access all my learning materials online, and that all my results and all my student correspondence will be received online *

How do you rate your computer skills? *

Excellent
Good
Basic
Poor

How do you rate your ability to work with numbers? *

Excellent
Good
Basic
Poor

Do you need any additional support? *

If yes, please specify *

What industry are you currently employed in? *

Not currently employed
Accommodation and food services
Administrative and support services
Arts and recreation services
Construction
Education and training
Electricity, gas, water, waste services
Financial and insurance services
Health care and social assistance
Information media and telecommunications
Manufacturing
Mining
Professional, scientific, technical services
Public administration and safety
Retail Trade
Transport, postal and warehousing
Wholesale trade
Other

License Code? *A unique license code would have been provided to you if this course were previously purchased through a company or other arrangement. No (proceed to payment) *

Amount

Price: $311.50

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